NR548/ NR 548 2024 -2025 PSYCHIATRIC
ASSESSMENT FOR THE PSYCHIATRIC-MENTAL
HEALTH NURSE PRACTITIONER REVIEW COVERED
QUESTIONS WITH CORRECT DETAILED ANSWERS
GRADED A+
John is a 36-year-old with a diagnosis of schizophrenia. He lives with his mother. His
symptoms are currently well managed by medications; however, he sometimes forgets to
take them. At the visit with the PMHNP, John asks the PMHNP to go over his medication
regimen with his mother.
Is this allowed under HIPAA?
Yes
Rationale: In situations where the client is given the opportunity and does not object, HIPAA
allows the provider to share or discuss the client's mental health information with family
members or other persons involved in the client's care or payment for care.
John's sister calls the PMHNP to discuss her concerns that John is under a lot of stress and
may be showing signs of psychosis. John has not permitted the PMHNP to speak with his
sister as they are estranged, and John has asked the PMHNP not to share information.
Is it acceptable for the PMHNP to share information about John's status with his sister?
No
Rationale: The HIPAA Privacy Rule permits a health care provider to disclose information to
the family members of an adult client who has the capacity and indicates that he or she
does not want the disclosure made, only to the extent that the provider perceives a serious
and imminent threat to the health or safety of the client or others and the family members
are in a position to lessen the threat. Otherwise, under HIPAA, the provider must respect
the wishes of the adult client who objects to the disclosure.
,Is it permissible for the PMHNP to listen to the sister's concerns without sharing
information?
Yes
Rationale: HIPAA in no way prevents health care providers from listening to family members
or other caregivers who may have concerns about the health.
John's mother recently had a stroke and is in the neuro intensive care unit (ICU). With his
mother out of the home, John has forgotten to take his medications for over a week. He
begins to experience hallucinations and paranoia. At his appointment with the PMHNP, he
threatens to harm his sister.
To whom should the PMHNP disclose this information (select all that apply):
-John's sister
-John's mother's nurse in the neuro ICU
-Law enforcement near the sister's home
-A social worker from the Board of Developmental Disabilities who has been working with
the family
-John's sister
-Law enforcement near the sister's home
-A social worker from the Board of Developmental Disabilities who has been working with
the family
Rationale: The Privacy Rule permits a health care provider to disclose necessary information
about a client to law enforcement, family members of the client, or other persons when the
provider believes the client presents a serious and imminent threat to self or others.
Specifically, when a health care provider believes in good faith that such a warning is
necessary to prevent or lessen a serious and imminent threat to the health or safety of the
client or others, the Privacy Rule allows the provider, consistent with applicable law and
standards of ethical conduct, to alert those persons whom the provider believes are
reasonably able to prevent or lessen the threat.
, Informed Consent
for care and treatment is a fundamental ethical and legal principle
-respects the client's autonomy in medical decision-making
-Clients have the right to receive information and ask questions about recommended
treatments so they can make decisions about their care that are consistent with their
beliefs, values, and goals of treatment
-Clients have the right to knowledge about their treatment under "reasonable practitioner"
or "reasonable person" standards under U. S. law.
-may change over time and in different circumstances
• is an ongoing process
Steps to Obtaining Informed Consent
-Assess client ability to understand medical information & tx options & to make a voluntary
decision
-Present relevant information with accuracy and sensitivity, Should include information
about:
• Diagnosis
• Nature and purpose of treatment options
• Benefits, risks, and burdens of all treatment options, including forgoing treatment
-Document informed consent conversation in the medical record, including all consent
forms
Informed Consent: Documentation
Documentation of the discussion to obtain informed consent should include:
-treatment plans with risks and benefits identified
-reasonable alternatives with risks and benefits identified
-assessment of client understanding of the discussion
*must demonstrate that the client participated in the decision-making process and that the
client was not coerced into treatment
ASSESSMENT FOR THE PSYCHIATRIC-MENTAL
HEALTH NURSE PRACTITIONER REVIEW COVERED
QUESTIONS WITH CORRECT DETAILED ANSWERS
GRADED A+
John is a 36-year-old with a diagnosis of schizophrenia. He lives with his mother. His
symptoms are currently well managed by medications; however, he sometimes forgets to
take them. At the visit with the PMHNP, John asks the PMHNP to go over his medication
regimen with his mother.
Is this allowed under HIPAA?
Yes
Rationale: In situations where the client is given the opportunity and does not object, HIPAA
allows the provider to share or discuss the client's mental health information with family
members or other persons involved in the client's care or payment for care.
John's sister calls the PMHNP to discuss her concerns that John is under a lot of stress and
may be showing signs of psychosis. John has not permitted the PMHNP to speak with his
sister as they are estranged, and John has asked the PMHNP not to share information.
Is it acceptable for the PMHNP to share information about John's status with his sister?
No
Rationale: The HIPAA Privacy Rule permits a health care provider to disclose information to
the family members of an adult client who has the capacity and indicates that he or she
does not want the disclosure made, only to the extent that the provider perceives a serious
and imminent threat to the health or safety of the client or others and the family members
are in a position to lessen the threat. Otherwise, under HIPAA, the provider must respect
the wishes of the adult client who objects to the disclosure.
,Is it permissible for the PMHNP to listen to the sister's concerns without sharing
information?
Yes
Rationale: HIPAA in no way prevents health care providers from listening to family members
or other caregivers who may have concerns about the health.
John's mother recently had a stroke and is in the neuro intensive care unit (ICU). With his
mother out of the home, John has forgotten to take his medications for over a week. He
begins to experience hallucinations and paranoia. At his appointment with the PMHNP, he
threatens to harm his sister.
To whom should the PMHNP disclose this information (select all that apply):
-John's sister
-John's mother's nurse in the neuro ICU
-Law enforcement near the sister's home
-A social worker from the Board of Developmental Disabilities who has been working with
the family
-John's sister
-Law enforcement near the sister's home
-A social worker from the Board of Developmental Disabilities who has been working with
the family
Rationale: The Privacy Rule permits a health care provider to disclose necessary information
about a client to law enforcement, family members of the client, or other persons when the
provider believes the client presents a serious and imminent threat to self or others.
Specifically, when a health care provider believes in good faith that such a warning is
necessary to prevent or lessen a serious and imminent threat to the health or safety of the
client or others, the Privacy Rule allows the provider, consistent with applicable law and
standards of ethical conduct, to alert those persons whom the provider believes are
reasonably able to prevent or lessen the threat.
, Informed Consent
for care and treatment is a fundamental ethical and legal principle
-respects the client's autonomy in medical decision-making
-Clients have the right to receive information and ask questions about recommended
treatments so they can make decisions about their care that are consistent with their
beliefs, values, and goals of treatment
-Clients have the right to knowledge about their treatment under "reasonable practitioner"
or "reasonable person" standards under U. S. law.
-may change over time and in different circumstances
• is an ongoing process
Steps to Obtaining Informed Consent
-Assess client ability to understand medical information & tx options & to make a voluntary
decision
-Present relevant information with accuracy and sensitivity, Should include information
about:
• Diagnosis
• Nature and purpose of treatment options
• Benefits, risks, and burdens of all treatment options, including forgoing treatment
-Document informed consent conversation in the medical record, including all consent
forms
Informed Consent: Documentation
Documentation of the discussion to obtain informed consent should include:
-treatment plans with risks and benefits identified
-reasonable alternatives with risks and benefits identified
-assessment of client understanding of the discussion
*must demonstrate that the client participated in the decision-making process and that the
client was not coerced into treatment
